scholarly journals Reliability of preoperative MRI findings in patients with lumbar spinal stenosis

2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Hasan Banitalebi ◽  
Ansgar Espeland ◽  
Masoud Anvar ◽  
Erland Hermansen ◽  
Christian Hellum ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Interobserver Agreement ◽  
Facet Joint ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
Intraobserver Agreement ◽  
Mri Findings ◽  
Cross Sectional ◽  
Facet Joint Osteoarthritis ◽  
Dural Sac

Abstract Background Magnetic Resonance Imaging (MRI) is an important tool in preoperative evaluation of patients with lumbar spinal stenosis (LSS). Reported reliability of various MRI findings in LSS varies from fair to excellent. There are inconsistencies in the evaluated parameters and the methodology of the studies. The purpose of this study was to evaluate the reliability of the preoperative MRI findings in patients with LSS between musculoskeletal radiologists and orthopaedic spine surgeons, using established evaluation methods and imaging data from a prospective trial. Methods Consecutive lumbar MRI examinations of candidates for surgical treatment of LSS from the Norwegian Spinal Stenosis and Degenerative Spondylolisthesis (NORDSTEN) study were independently evaluated by two musculoskeletal radiologists and two orthopaedic spine surgeons. The observers had a range of experience between six and 13 years and rated five categorical parameters (foraminal and central canal stenosis, facet joint osteoarthritis, redundant nerve roots and intraspinal synovial cysts) and one continuous parameter (dural sac cross-sectional area). All parameters were re-rated after 6 weeks by all the observers. Inter- and intraobserver agreement was assessed by Gwet’s agreement coefficient (AC1) for categorical parameters and Intraclass Correlation Coefficient (ICC) for the dural sac cross-sectional area. Results MRI examinations of 102 patients (mean age 66 ± 8 years, 53 men) were evaluated. The overall interobserver agreement was substantial or almost perfect for all categorical parameters (AC1 range 0.67 to 0.98), except for facet joint osteoarthritis, where the agreement was moderate (AC1 0.39). For the dural sac cross-sectional area, the overall interobserver agreement was good or excellent (ICC range 0.86 to 0.96). The intraobserver agreement was substantial or almost perfect/ excellent for all parameters (AC1 range 0.63 to 1.0 and ICC range 0.93 to 1.0). Conclusions There is high inter- and intraobserver agreement between radiologists and spine surgeons for preoperative MRI findings of LSS. However, the interobserver agreement is not optimal for evaluation of facet joint osteoarthritis. Trial registration www.ClinicalTrials.gov identifier: NCT02007083, registered December 2013.

scholarly journals Clinical and MRI findings in lumbar spinal stenosis: baseline data from the NORDSTEN study

2021 ◽  
Author(s):  
Jørn Aaen ◽  
Ivar Magne Austevoll ◽  
Christian Hellum ◽  
Kjersti Storheim ◽  
Tor Åge Myklebust ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Patient Characteristics ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
Mri Findings ◽  
Multifidus Muscle ◽  
Cross Sectional ◽  
Patient Reported ◽  
Lumbar Spinal

Abstract Purpose The aim was to describe magnetic resonance imaging findings in patients planned for lumbar spinal stenosis surgery. Further, to describe possible associations between MRI findings and patient characteristics with patient reported disability or pain. Methods The NORDSTEN spinal stenosis trial included 437 patients planned for surgical decompression of LSS. The following MRI findings were evaluated before surgery: morphological (Schizas) and quantitative (cross-sectional area) grade of stenosis, disk degeneration (Pfirrmann), facet joint tropism and fatty infiltration of the multifidus muscle. Patients were dichotomized into a moderate or severe category for each radiological parameter classification. A multivariable linear regression analysis was performed to investigate the association between MRI findings and preoperative scores for Oswestry Disability Index, Zurich Claudication Questionnaire and Numeric rating scale for back and leg pain. The following patient characteristics were included in the analysis: gender, age, smoking and weight. Results The percentage of patients with severe scores was as follows: Schizas (C + D) 71.3%, cross-sectional area (< 75 mm2) 86.8%, Pfirrmann (4 + 5) 58.1%, tropism (≥ 15°) 11.9%, degeneration of multifidus muscle (2–4) 83.7%. Regression coefficients indicated minimal changes in severity of symptoms when comparing the groups with moderate and severe MRI findings. Only gender had a significant and clinically relevant association with ODI score. Conclusion In this cross-sectional study, the majority of the patients had MRI findings classified as severe LSS changes, but the findings had no clinically relevant association with patient reported disability and pain at baseline. Patient characteristics have a larger impact on disability and pain than radiological findings. Trial registration www.ClinicalTrials.gov identifier: NCT02007083, registered December 2013.

scholarly journals Dural Sac Cross-Sectional Area Does Not Correlate with Efficacy of Percutaneous Adhesiolysis in Single Level Lumbar Spinal Stenosis

2011 ◽  
Vol 4;14 (4;7) ◽  
pp. 277-282
Author(s):  
Dr. Chan Hong Park
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Cross Sectional Area ◽  
Low Back ◽  
Sectional Area ◽  
Cross Sectional ◽  
Epidural Steroid Injections ◽  
Dural Sac ◽  
Lumbar Spinal ◽  
Epidural Steroid

Background: Spinal stenosis is a narrowing of the spinal canal, which causes mechanical compression of spinal nerve roots. The compression of these nerve roots can cause low back pain and/or leg pain, as well as neurogenic claudication. Lumbar epidural steroid injections have commonly been used in patients with lumbar spinal stenosis (LSS). In cases that are refractory to epidural steroid injections, percutaneous epidural adhesiolysis has been used. Objective: The aim of our study is to determine the relationship between the severity of spinal stenosis and the participants’ response to adhesiolysis, and to evaluate the mid-term effectiveness of adhesiolysis. Study Design: A prospective observational study. Methods: Sixty-six patients with degenerative LSS were enrolled in this prospective study. All participants underwent lumbar spine magnetic resonance imaging (MRI). The cross-sectional area of the dural sac was measured on the transverse angled sections through the central part of the disc on conventional MR images. All percutaneous adhesiolyses were performed in the operating room. One hour following the procedure, 6 mL of 8% sodium chloride solution was infused during 30 minutes in the recovery room while the patient underwent monitoring. Outcome measures were obtained using the 5-point patient satisfaction scale at 2 weeks and 6 months post-treatment. To evaluate outcome predictors, we divided the participants into 2 groups according to their response to treatment. Limitations: Secondary outcomes were not measured and the study did not include a long-term follow-up period. Results: Improvement (including reports of slightly improved, much improved, and no pain) was observed in 49 participants (74.2%) at 2 weeks and 45 participants (66.7%) at 6 months after the procedure. The dural sac cross-sectional area (DSCSA) did not differ between participants who reported improvement and those who did not. There was no statistically significant correlation between pain relief and DSCSA, age, or participant sex. Conclusion: Percutaneous adhesiolysis was shown to be effective for the treatment of LSS, with mid-term result, without affecting DSCSA. Key words: Low back pain, lumbar spinal stenosis, failed back surgery syndrome, dural sac, interventional techniques, epidural injection, percutaneous adhesiolysis.

Axial loading during supine MRI for improved assessment of lumbar spine: comparison with standing MRI

2021 ◽  
pp. 028418512110681
Author(s):  
Jarruwat Charoensuk ◽  
Jiraporn Laothamatas ◽  
Witaya Sungkarat ◽  
Ladawan Worapruekjaru ◽  
Boonthida Hooncharoen ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Intervertebral Disc ◽  
Spinal Stenosis ◽  
Weight Bearing ◽  
Cross Sectional Area ◽  
Spinal Curvature ◽  
Sectional Area ◽  
Cross Sectional ◽  
Compression Device ◽  
Dural Sac

Background There are no studies comparing the morphologic changes of lumbar spines between supine axial-loaded and 90° standing magnetic resonance imaging (MRI) examinations of patients with spinal stenosis. Purpose To determine whether axial-loaded MRI using a compression device demonstrated similar morphology of intervertebral disc, dural sac, and spinal curvature as those detected by 90° standing MRI in individuals with suspected spinal stenosis. Material and Methods A total of 54 individuals suspected of having spinal stenosis underwent both axial-loaded and standing MRI studies. The outcome measures included seven radiologic parameters of the lumbar spine: measures of the intervertebral disc (i.e. cross-sectional area [DA], disc height [DH], and anteroposterior distance [DAP]), dural sac (cross-sectional area [DCSA]), spinal curvature (i.e. lumbar lordosis [LL] and L1-L3-L5 angle [LA]), and total lumbar spine height (LH). Results For agreement between the two methods, intraclass correlation coefficient (ICC) ≥ 0.8 was found for all seven radiologic parameters. Supine axial-loaded MRI underestimated LL but remained correlated (ICC = 0.83) with standing MRI. Minor differences between the two methods (≤5.0%) were observed in DA, DCSA, DAP, LA, and LH, while a major difference was observed in LL (8.1%). Conclusion Using a compression device with the conventional supine MRI to simulate weight-bearing on the lumbar spine generated MRI morphology, which was strongly correlated with those from a standing MRI.

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